Essay Sample on Advanced Nursing: Childhood Insomnia

Introduction

Advanced nursing practice is a study of the way nurses operate in a complex of the dynamic realm of medicine, examining both theoretical fundamentals of nursing and challenges faced by nurses in the current clinical setups that brings difficulties adhering to the established models. The main aim is to answer the question various theoretical models have addressed but not resolved completely; how can one live up best in the nurse's code of ethics at the same time provide treatment in the ever-changing clinical set-up?

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The truth is that nursing practice emulates theoretical models but it is not usually possible. Nurses always experience a detachment between the treatment alternatives presented theoretically and in reality. Getting frustrated can lead to them abandoning those models, even in cases where they are warranted in support of what has succeeded in their experience. At times, the nurses are even pressured to leave their models due to respect for the prevailing hospital or clinic's policy. One of the actual challenges today in the nursing field is finding a way to bridge the gap between theory and practice, childhood insomnia being the phenomena of interest in the nursing practice.

Phenomenon of Interest

The phenomenon of interest in this paper is the childhood insomnia. In the nursing practice, insomnia refers to sleep disturbance where children often struggle to fall asleep or stay awake at night. Childhood insomnia may be experienced in instances where children attempt to wake up too early. In many cases, older children may complain about the above issue on their own while youngsters may bring it to the attention of the people (Owens & Mindell, 2011). The complaints about insomnia are in most cases, associated with the feeling of non-restorative sleep and impairment during daytime functioning.

In nursing, the classification of insomnia is often based on the duration, long-term or short-term, the frequency of the problem as well as the severity. Short-term insomnia always lasts for a few days or weeks and it is usually caused by factors that are easy to prevent at an early stage. Long-term insomnia, on the other hand, occurs three times within a week and it may last for months; it is however caused by factors that require medical attention from the qualified nurses or other medical practitioners. Some of the symptoms of childhood insomnia include depression, pain, anxiety and medical problems (Meltzer, 2010).

In younger children, the dependence on the parent to initiate sleep and bedtime resistance are also considered to be forms of insomnia. In the current research, it is evidenced that during childhood, there is always the predominance of behavioral insomnia which comes in the form of sleep-onset association disorder. Childhood insomnia is more associated with the delayed sleep phase as well as the sleep hygiene problems. In children, psychiatric, depression and anxiety or in other words, neurodevelopmental disorders involving autism, attention deficit disorders and epilepsy often occur in association with or as a comorbidity of sleeplessness.

Insomnia complaints in adolescents and children should be effectively addressed in the medical field and appropriately explored by the pediatrician, considering the relationship with diverse comorbidities, which ought to be investigated. The triggering factors or the causes of insomnia usually vary according to the developmental levels and age. However, the therapeutic approach ought to include sleep hygiene as well as behavioral techniques. At the individual level, the treatment approach may take the pharmacological approach.

In the current studies, it is well established that the best approach for treating childhood insomnia is cognitive behavioral therapy (CBT-I). However, some medications may prove to be effective in the short term basis but CBT-I often proves to be superior on the long term basis. The recent study published in the sleep medicine involved the longest follow-up valuations of the treatment outcomes in the childhood insomnia (Van Geijlswijk et al., 2011).

When it comes to the treatment of the childhood insomnia, some of the approaches use the extinction technique, the process that involves putting a child in bed at specific times and leaving them there until they fall asleep without the attention from anybody. The goal of the above technique is to avoid rewarding children with the attention to avoid falling asleep. However, there are also positive routines that reward bedtime interactions with the caregiver. To avoid childhood insomnia, there is also an approach of bedtime fading that involves delaying a child's bedtime to march their normal sleep onset time. Positive routines usually assist children to adopt cues for sleep onset. On the other hand, bedtime fading escalates the possibility of a child experiencing quick sleep onset when taken to the bed. With the above approach, improvement can be noticed within one to two weeks; the treatment, however, may last for six sessions.

Metaparadigm

In nursing, metaparadigm refers to the set of ideas or theories that provide the structures of how discipline should operate. According to Fawcett, Watson, Neuman, Walker, & Fitzpatrick, (2001), the four main concepts of nursing that we are going to define comprehensively are a person, environment, health, and nursing.

The human concept of caring has got more attention due to its importance to the concept of caring as a principle of nursing. It gives much emphasis on spiritual importance, rather than the physical and human dimensions. It emphasizes on the self-actualization and transcendence of the nurse in their caring experience. Children with insomnia need not only a comprehensive view for the nurse-patient encounter, but also analyses on the theoretical philosophy and definitions on the main concepts such as self-healing, conciseness-transcendence and the peace of mind, soul and body. This theory is different from the other theories in that it focuses on spirituality rather than the others which focus mainly on the physical.

The environment concept is the external and internal impacts that affect the patient. It creates the question about world existence, without involving the human factor. It focusses on the subsidiary effects of the global happenings such as ecological issues, ethnic wars, on every child in the world, which are often ignored.

Childhood insomnia impacts the children's well-being and general health and as a result, it touches on one of the meta-paradigm of nursing as indicated above. While introducing the therapeutic approaches in trying to reduce the cases of childhood insomnia, there is the applications of metaparadigm which facilitates the understanding of the theories and set of ideas that need to be employed (FernandezMendoza et al., 2014). Through the application of the metaparadigm, therapeutic professionals are able to understand how chronic insomnia in childhood responds to the behavioral treatments that aim at eliminating anxiety and stopping the behaviors that end up perpetuating and worsening different conditions.

In the meta-paradigm of nursing, there are cognitive behavioral therapies that target actions and thoughts that lead to childhood insomnia. According to the four components of the nursing metaparadigm, the medical interventions of childhood insomnia should incorporate cognitive behavioral therapy that targets the actions and thoughts that disrupts sleep in children. The above scenario may include relaxation training to reduce anxiety. The procedure should focus on establishing the sleep schedules that restricts that children spend on the bed while still awake.

According to the metaparadigm, the effective treatments for childhood insomnia encourages good sleep hygiene which may include sleeping and waking up at the same time daily including weekends, getting familiarized with the simple meditations and practicing them every day before bedtime and getting adequate physical exercise during the day (Zhou et al., 2014). Some other metaparadigm interventions aimed at eradicating childhood insomnia include limiting caffeine intake and restricting it to specific times in the morning hours. Additionally, avoiding alcohol which is one of the greatest sleep disrupters and keeping the bedroom dark are some of the best practices that can lead to the reduction of childhood insomnia.

Grand Nursing Theory

Grand nursing theories involve the rigorous and creative structuring of different ideas that project a purposeful, tentative and the systematic view of a given phenomenon. Through the systematic inquiry, nurses are able to create knowledge that aims at improving the care of the patients. Grand nursing theory includes the coherent groups of general positions used as the principles of explanations (Neuman & Fawcett, 2002).

Grand nursing theories include the conceptual framework that defines the broader perspectives for ways of looking at nursing and for practices at nursing phenomena depending on the perspectives. The theories have been among the most important tools in explaining, guiding and improving the practices of nursing (Neuman & Fawcett, 2002). Grand nursing theories have contributed immensely to the growth of nursing practices. Some of the grand nursing theories include Callista Roy and Dorothea Orem theory.

Orem's grand nursing theory is based on the foundation that people should struggle to meet their individual care needs through self-care. Additionally, Orem's grand nursing theory relies on the assumptions around the individual's independent in everyday life. Orem's theory consists of three major subsets, self-care deficit, self-care as well as nursing systems. When it comes to the treatment processes or the therapeutic procedures in the childhood insomnia, the concepts in Orem's theory are essential. To end or eradicate childhood insomnia, there is always the need for self-care; however, this may become impossible in children and as a result, parents and other people involved should take the center stage in an attempt to end childhood insomnia.

Orem Self-Care Model is a model that was developed by Dorothea Orem working towards enhancing the quality of nursing in most of the general hospitals in her state. The model interrelates concepts and components in a manner to create a defined way of looking at a particular phenomenon. The Orem Self-Care Model has requisites which are connected to life processes and mechanisms including the maintenance of the strength of human structure and functioning and described as activities of daily living such as: the maintenance of enough intake of air, food and water, provision of care associated with the elimination process, a balance between activities and rest, as well as between solitude and social interaction, prevention of hazards to human life and well-being and promotion of human functioning.

As far as childhood insomnia is concerned, Orem's grand theory provides the best procedures and techniques on how to terminate the sleep problems specifically among the children (Orem, 1995). Orem's grand theory stipulates that when it comes to the childhood insomnia, there are three major types of stimuli that need to take the center stage i.e. circumstances, conditions, and influences. The above stimuli often attempt to interfere with an individual's four modes of functionality including self-concept, physiologic needs, role function, and interdependence. Childhood insomnia is both psychological and health conditions and as a result, it interferes with a child normal living conditions.

Orem's theory revolves around the idea that health is a range of a continuum of degrees that encompass both wellness and sickness. The theory is thus important in developing the plans for nursing care that aids...